The time limit for medical insurance reimbursement is generally half a year, that is, reimbursement should be within six months after diagnosis and treatment.
Generally, the second half of the year is reimbursed for the first half of the year, and the first half of this year is reimbursed for the second half of the previous year.
If timely reimbursement is implemented upon discharge, the non-reimbursed portion can be paid upon discharge, and the proportions vary from place to place.
Medical bills and other reimbursement documents that are more than half a year old may not be reimbursed.
Even if reimbursement is possible, the scope of reimbursement is limited.
According to relevant legal provisions, medical expenses that meet the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance fund in accordance with national regulations.
Article 29 of the "Social Insurance Law of the People's Republic of China" The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.
The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.
Article 30 The following medical expenses are not included in the payment scope of the basic medical insurance fund: (1) Those that should be paid from the work-related injury insurance fund; (2) Those that should be borne by a third party; (3) Those that should be borne by the public health department
; (4) Seeking medical treatment abroad.
Medical expenses should be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first.
After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.